UnitedHealthcare Community Plan of North Carolina · 2019. 9. 5. · Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth

UnitedHealthcareCommunity Plan of North Carolina

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Value-based Strategy

2

UnitedHealthcare’s value-based

compensation models are categorized

into three general areas:

1. Performance-based programs.

2. Bundled and episode-based

programs.

3. Accountable care programs.


Social Determinants and VBP

3

• Of the soon-to-be 40

states that provide

Medicaid services

through risk-based

managed care plans, 35

include SDOH activities

related to screening

and/or referrals and

care coordination in

their MCO contracts

Value-Based Purchasing:

A path to improve Quality and Health.


Delivering on the Triple Aim

Better Quality

Lower Cost

Triple Aim

Better Experience

•Providers and Patients

Health Plan

State Partners

Member Health

Primary Care Providers

5

We seek to align incentives across the many stakeholders that fund and deliver care to the most

vulnerable populations by driving increased adoption and effectiveness of value based

payment and care delivery.


North Carolina Medicaid

• North Carolina Medicaid will leverage the LAN APM Framework as a guide

to move away from fee-for-service and towards VBP.

• Payment arrangements between PHPs and providers that fall within Levels

2 through 4 of the multi-payer Health Care Payment (HCP) Learning and

Action Network (LAN) Alternative Payment Model (APM) framework,

• DHHS requires that by the end of Year 2 of PHP operations, the portion of

each PHP’s medical expenditures governed under VBP arrangements will

either increase by twenty (20) percentage points, or represent at least fifty

percent (50%) of total medical expenditures. (RFP Scope of Services

Addendum - Page 175)

6


Value Based Payment

7


North Carolina- Improved Value

Value of Local

Value of Managed

Care

Value for the Communities

• In-person,

localized care

• Continuity of local

providers

• Integrated

community of

health

• Depth of

resources and

best practices

from experience

• Sophisticated

support system,

including data

analytics and VBP

Singular focus


Benefits of

Value-Based

Purchasing


VBP

VBP improves partnership with Medicaid care providers to drive better quality

care and better value for our Medicaid members and state partners

• Collaborate with care providers by:

• meeting practices where they are in their ability to bear risk,

• helping them navigate VBP

• providing a glide path for them to follow as they change the way

they deliver care and accept increasing levels of risk.

10


Shift to Value-Based Payment

Source: “APM Measurement: Progress of Alternative Payment Models”, HCP-LAN, 2018.

▪ 34% of U.S. healthcare payments were “value-based” in 2017, up from 23% in 2015,

according to research conducted by the Healthcare Payment Learning and Action Network

(HCP-LAN).*

▪ Value-based arrangements were most common in Medicare but are widespread across

payers.

*Payments categorized as level 3 (alternative payment models built on FFS architecture with

upside/downside risk) or 4 (population based payment) under the Healthcare Payment Learning and

Action Network (HCP-LAN) alternative payment model framework.

Percentage of Healthcare Payments in Level 3 or 4 Payment Models by

Payer (2017)

National Landscape

North Carolina Medicaid’s increasing focus on value-based payment

(VBP) is part of a broader shift in payment models across payers.


Focus on supporting the delivery of person-centered care

Under VBP arrangements, consumers are at the center of

the health care experience supported by a more

coordinated care team.

VBP emphasizes high quality care that is delivered in an

efficient manner and care that takes into account the

preferences, needs, and values of individuals and their

caregivers.

12

VBP Benefits


Heightened incentive to coordinate care.

VBP supports coordination both within the health care

system and among different entities and organizations.

Technology, access to data, and financial incentives

support care providers in coordinating care for individuals

across the health care continuum.

13

VBP Benefits


Encourages proactive care.

VBP incentivizes care providers to keep consumers

healthy and close gaps in care.

Approach uses research and evidence-based practices to

address proactively the social, environmental, and

medical factors that contribute to an individual’s health

and influence healthy outcomes rather than reactively

treating an illness or disease.

14

VBP Benefits


Emphasis on collaboration and transparency.

Payers and care providers share a common goal of better

outcomes as opposed to a fragmented system where

payment is solely based on services rendered.

15

VBP Benefits


Reduction in health care waste.

Value is the new standard for payers and care providers, and reimbursement

is based on quality and individual health improvements.

These outcomes positively affect both the lives of individuals and the health

care system’s bottom line.

16

VBP Benefits


State Value-Based

Purchasing

Experience


Arizona

• The Arizona Health Care Cost Containment System has

required its contracted Managed Care Organizations

(MCOs) to implement VBP reform since 2014.

• MCOs in Arizona are required to have 50% of all

payments to providers tied to value; however, the state

allows MCOs the flexibility to develop models that

meaningfully engage providers

18


Hawai’i

• Since 2013, Hawai’i Med-Quest (Medicaid) has required

its contracted MCOs to incorporate VBP requirements

into their provider contracts.

• Beginning in 2017, Hawai’i requires 80% of payments to

care providers to be in VBP arrangements. MCO’s have

discretion on how to implement VBP arrangements, but

all MCOs are required to use the same quality

measures.


Pennsylvania

• Pennsylvania was an early leader in VBP reform, as the

state has had a VBP strategy in place since 2013.

• Pennsylvania requires its contracted MCOs to have 30%

of all payments to care providers subject to VBP by the

end of 2019, and in 2018, the state announced

requirements that Behavioral Health Managed Care

Organizations must also implement VBP models that

increase over the life of the contract.

20

Thank you.

Documents

UnitedHealthcare Community Plan of North Carolina · 2019. 9. 5. · Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth